Provider Demographics
NPI:1164893699
Name:GILLETT, RAYMOND MICHAEL (LMSW, LAC, MDIV)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:MICHAEL
Last Name:GILLETT
Suffix:
Gender:M
Credentials:LMSW, LAC, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7308 W HALE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3141
Mailing Address - Country:US
Mailing Address - Phone:860-428-9547
Mailing Address - Fax:
Practice Address - Street 1:7308 W HALE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3141
Practice Address - Country:US
Practice Address - Phone:860-428-9547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-09
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4877101Y00000X, 101YM0800X, 104100000X, 1041C0700X
KS001101YA0400X
101YP1600X, 171M00000X, 172V00000X, 171M00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker